An article on pelvic abscess

This is the collection of pus any where in female pelvis . This abscess may form the pouch of Douglas in the tube in the ovary and the tube, in the ovary alone.

Causes :-

STD ,puerperial sepsis,septic abortion following pelvic surgery or IUCD or secondary to appendicitis and diverticulitis.
The commonest infection is endogenous,vaginal or bowel bacteria anaerobes,aerobes .
Secondarily invading tissue damaged by delivery, abortion, surgery and venereal disease.
Pelvic peritoneum may be involved as an extension from general peritonitis following appendicitis, perforation of intestinal ulcer.
In the pelvic abscess,with in the pouch of Douglas,colis of the intestine,omentum form the roof of the abscess from the general peritoneal cavity .It leads to septic shock.

In pyosalpinx ,both the tubes are commonly infected adhesion ,fibrial end may be indrawn.The contents are thick or thin pus.

Microscopically the tube wall shows muscular atrophy and replacement fibrosis with leukocytic and round cell infiltration.

Complications :-

Adhesions with surrounding bowels , rupture and tortion .
Tubo ovarian mass.

Clinical features:-

History of any of the causative factor.
Daily raise of body temperature intermittent type.
Pain in lower abdomen
Frequent passing of loose, mucoid stools.

Signs :-

Signs of infection like, flushed face
Increased pulse rate
Toxic look
Upper abdomen shows tenderness and rigidity.
Lower abdomen :- A tender mass with indefinite margins may be felt in hypogastric or iliac fossa region.

Per vaginal:-

Hot and tender uterus is pushed anteriorly ,the movement of cervix is painful. A flacuent elastic tender swelling commonly felt in front of the rectum.

Diagnosis:-

Blood: Leukocytosis with high polymorph count . Needling pouch of Douglas or abscess in the parametrium reveals pus which is send for gram stain , culture and sensitivity test to identify the organism.
Abdominal skiagram and pelvic sonogram.

Pelvic haematocele

Infected ovarian cyst or fibroid

Treatment :

1.General measure
Semi recumbent bed rest
Sedative plenty of of fluids
Systematic antibiotics given parenterally
Heat application to the lower abdomen

Local treatment:

When the abscess seems to be localised,the pus is drained by proper incision posterior calpotomy , Definite surgery to drain the pus through posterior fornix.
Pus should send for culture and sensitivity.

Management :-

Proper preparation for vaginal operation under general anaesthesia.

A posterior vaginal speculum is applied.

This procedure help to drain the pus.
The abscess cavity is packed sterile with roller gauze socked out with solution and the end of the gauze brought out through the opening in the vagina for drainage.
Administration of appropriate antibiotics.

Removal of gauze drainage on the next .

After the drainage of the pelvic abscess treat further for anemia .

Abdominal physiotherapy

Abdominal drainage by laparatomy for tuboovarian abscess.

Removal of pelvic mass and hysterectomy

Complications of posterior calpotomy

Injury to the rectum and uretus , generalized peritonitis.